Surgical instrument with commonly actuated robotic and manual features

ABSTRACT

A surgical instrument may comprise a chassis configured to be removably coupled with a surgical robotic manipulator and may comprise an elongate flexible shaft coupled to the chassis. The surgical instrument may also comprise a robotic actuation piece coupled to and rotatable relative to the chassis and a manual actuator coupled to and translatable relative to the chassis. A rack gear may be engaged with the manual actuator and with the robotic actuation piece. The rack gear may be movable by the robotic actuation piece and by the manual actuator to control an operation of the elongate flexible shaft.

COPYRIGHT NOTICE

A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 13/446,978 (filed Apr. 13, 2012) and is related to and claims priority to U.S. Patent Application No. 61/524,241 (filed Aug. 16, 2011; entitled “Surgical Instrument with Commonly Actuated Robotic and Manual Features,” by Radgowski et al.), the contents of each of which are incorporated herein by reference in their entirety and for all purposes.

BACKGROUND

The present disclosure relates generally to surgical instruments, and more particularly to steerable and articulate surgical instruments having robotically actuated features and manually actuated features.

In the field of robotic surgery and machine-aided surgical procedures there is the need to rapidly and efficiently introduce material to, and remove material from, the surgical area. For example, in some situations it is desirable to remove blood accumulation near a surgical site in order to maintain good visibility for the surgeons. Similarly, it is desirable to remove smoke during endoscopic procedures to maintain good visibility. In some situations it is desirable to introduce a gas to inflate a body cavity that includes an organ or a tissue that is involved in surgery. Such insufflation provides sufficient space for the surgeon to move the surgical instruments and for an adequate endoscopic field of view. In other situations, it may be desirable to irrigate the surgical area (e.g., with water or a saline solution), either for allowing visibility of the area of interest or to provide moisture to the tissue surrounding the area of interest.

During teleoperated robotic surgery (e.g., using a da Vinci® Surgical System, commercialized by Intuitive Surgical, Inc., Sunnyvale, Calif.), teleoperated surgical instruments are introduced through the patient's body wall in order to access and work at a surgical site. In situations in which surgical suction or irrigation is required, a patient side surgical assistant removes one of the robotically controlled instruments from its associated cannula, and then manually introduces a manually controlled instrument that provides suction or irrigation. The assistant then manually maneuvers and operates the suction or irrigation instrument while viewing the surgical site in a patient side monitor, while at the same time coordinating with the surgeon, who is operating the master surgical system control. Once the patient side assistant completes the suction or irrigation function, the manual instrument is removed and the robotic surgical instrument replaced. Thus, the need to use manually operated suction and irrigation instruments for surgical procedures that involve a telerobotic surgical system interferes with the surgical work flow. This need also defeats some of the advantages of the camera-referenced telepresence that such a surgical system offers. Nevertheless, there are situations in which a manually operated suction or irrigation instrument is desirable during a telerobotic surgical procedure, such as controlling the suction and irrigation functions and suction/irrigation instrument position as the surgeon operates two other telerobotic surgical instruments.

What is needed is a surgical instrument that provides the benefit of both teleoperated surgical operation and the benefit of operation by a patient side assistant.

SUMMARY

According to embodiments disclosed herein, an instrument may include an end effector at a distal end, an actuator mechanism at a proximal end, the actuator mechanism including a first valve, a robotic control coupled to the first valve, and a manual control coupled to the first valve. The instrument may further include a transport shaft between the actuator mechanism and the end effector, the transport shaft including a cavity, coupled to the first valve, that facilitates material transport along the transport shaft, the first valve having an actuating axis perpendicular to a rotational axis of the robotic control.

Further according to embodiments disclosed herein, a method for using an instrument with actuated features may include actuating a first valve in a proximal end of the instrument to access a cavity included in a transport shaft of the instrument, wherein actuating the first valve includes: actuating an actuator mechanism that includes a robotic control coupled to the first valve and a manual control coupled to the first valve in response to activation of the robotic control or the manual control in a direction perpendicular to a rotational axis of the robotic control.

Further according to some embodiments disclosed herein, a method of using an instrument may include coupling a material source to a cavity in the instrument; coupling a suction source to the cavity in the instrument; and actuating a first valve coupled to the cavity to access the material source using an actuator mechanism including a robotic control coupled to the first valve and a manual control coupled to the first valve. The method may further include actuating a second valve coupled to the cavity to access the suction source using an actuator mechanism including a robotic control coupled to the second valve and a manual control coupled to the second valve.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a perspective view of a surgical instrument according to some embodiments.

FIG. 2 illustrates a plan view of a proximal end mechanism according to some embodiments.

FIG. 3 illustrates a perspective view of a proximal end mechanism according to some embodiments.

FIG. 4 illustrates a perspective view of wrist orientation control features in a proximal end mechanism according to some embodiments.

FIG. 5 illustrates a perspective view of a distal end of a surgical instrument including a transport shaft, a wrist mechanism, and an end effector included in the surgical instrument according to some embodiments.

FIG. 5A illustrates a cross-sectional view of a wrist control scheme included in a surgical instrument according to some embodiments.

FIG. 5B illustrates a perspective view of a distal end of a transport shaft included in a surgical instrument according to some embodiments.

FIG. 6 illustrates a cross-sectional perspective view of a proximal end mechanism and a proximal portion of an instrument including a transport shaft, according to some embodiments.

FIG. 7A illustrates a cross-sectional perspective view of a proximal end mechanism included in a surgical instrument according to some embodiments.

FIG. 7B illustrates a cross-sectional perspective view of a proximal end mechanism included in a surgical instrument according to some embodiments.

FIG. 7C illustrates a cross-sectional perspective view of a proximal end mechanism included in a surgical instrument according to some embodiments.

FIG. 8 shows a flowchart of a method to use a surgical instrument according to some embodiments.

FIG. 9 shows a flowchart of a method to use a surgical instrument according to some embodiments.

DETAILED DESCRIPTION

The present disclosure relates generally to surgical instruments, and more particularly to steerable and articulate surgical instruments having robotically actuated features and manually actuated features. The combination of manually and robotically actuated features provides flexibility for the use of surgical instruments according to the present disclosure. For example, a steering mechanism may be actuated with a robotic mechanism controlled by a specialized surgeon, and a valve for irrigating tissue or suction of material from tissue may be manually operated. In such situations, the valve may be operated once the steering mechanism has placed a distal end of the surgical instruments in a desirable location relative to the area of interest.

The present application is related to the following U.S. patent Applications, all assigned to Intuitive Surgical Operations, Inc., the contents of which are incorporated herein by reference in their entirety and for all purposes: U.S. patent application Ser. No. 11/341,004 (filed Jan. 27, 2006; entitled “Robotic Surgical Instruments for Irrigation, Aspiration, and Blowing” by Millman et al.); U.S. patent application Ser. No. 11/341,155 (filed Jan. 27, 2006; entitled “Robotic Surgical Instruments with a Fluid Flow Control System for Irrigation, Aspiration, and Blowing” by Millman et al.); U.S. patent application Ser. No. 11/454,359 (filed Jun. 15, 2006; entitled “Robotic Surgical Systems with Fluid Flow Control for Irrigation, Aspiration, and Blowing” by Millman et al.); and U.S. patent application Ser. No. 11/454,476 (filed Jun. 15, 2006; entitled “Methods of Fluid Flow Control with Robotic Surgical Instruments for Irrigation, Aspiration, and Blowing” by Millman et al.).

FIG. 1 is a perspective view of a surgical instrument 1, according to some embodiments. Proximal and distal orientations are as shown by the arrows and are arbitrary terms. As shown in FIG. 1, surgical instrument 1 includes four portions: a proximal end mechanism 2, an elongate transport shaft 3, a wrist mechanism 4, and an end effector 5 at the distal end.

In the depicted embodiment, proximal end mechanism 2 is configured to be removably mated with a surgical robotic manipulator arm (not shown; e.g., a da Vinci® model IS3000 surgical system instrument manipulator arm commercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif.). Components in proximal end mechanism 2 function as force transmission mechanisms to receive teleoperated servo actuation forces from the surgical robotic manipulator and in turn redirect the received forces to operate components of instrument 1, such as changing the orientation of wrist 4 and operating other components in proximal end mechanism 2, as described below. In the depicted embodiment, proximal end mechanism 2 receives four separate actuation inputs from its associated robotic manipulator. In other embodiments, proximal end mechanism 2 may be modified to receive more or fewer inputs from an associated manipulator, depending on the number of instrument 1 features to be controlled. In some embodiments, proximal end mechanism 2 may include one or more motors that operate associated instrument 1 features, and such motor(s) rather than an external actuator provides force to operate the associated feature. In the depicted embodiment, there is no input that controls transport shaft 3 roll, although such a feature (known in other da Vinci® surgical system instruments) may be included in other embodiments.

Transport shaft 3 couples proximal end mechanism 2 to end effector 5, so that end effector 5 can be inserted through a patient's body wall to reach a surgical site while proximal end mechanism 2 remains outside the patient. In the depicted embodiment, the outer diameter of transport shaft 3 is about 8 mm, although this dimension can be varied for other embodiments. In addition, in the depicted embodiment transport shaft 3 is substantially rigid, although in some embodiments transport shaft 3 may be flexible (see e.g., U.S. patent Application Pub. No. US 2011/0071544 A1 (filed Nov. 13, 2009; entitled “Curved Cannula Instrument”), assigned to Intuitive Surgical Operations, Inc., the contents of which are incorporated herein by reference in their entirety). For this description, a longitudinal axis 6 that runs along the centerline of transport shaft 3 is defined for instrument 1. Further according to some embodiments, transport shaft 3 may include a cavity that provides material transfer along the shaft. For example, material may be transferred between a distal end of transport shaft 3 and a proximal end of transport shaft 3. In some embodiments, the material transfer may take place between a point near the proximal end of transport shaft 3 and a point near the distal end of transport shaft 3.

As shown in FIG. 1, wrist mechanism 4 is coupled between the distal end of transport shaft 3 and end effector 5. Features of wrist mechanism 4 are described in more detail below. In the depicted embodiment, wrist mechanism 4 allows end effector 5 to change orientation with two degrees of freedom (DOFs), arbitrarily termed pitch and yaw, with reference to axis 6. In some embodiments, wrist 4 may enable only a single DOF (e.g., pitch or yaw). In some embodiments, wrist mechanism 4 may enable more than two DOFs so that compound curves can be controlled. In yet other embodiments, wrist mechanism 4 may be eliminated so that end effector 5 is directly connected to the distal end of transport shaft 3.

In some embodiments, a pitch degree of freedom and a yaw degree of freedom include angular motions (changes of orientation) within a plane arbitrarily oriented in three-dimensional (3-d) space. Furthermore, a pitch plane may be oriented perpendicularly to a yaw plane, according to some embodiments.

End effector 5 is described in more detail below. In the depicted embodiment, end effector 5 is configured to accommodate both an irrigation function and a suction function at a surgical site. Therefore, an enclosed channel forming a lumen extends from end effector 5, through wrist 4 and transport shaft 3, to proximal end mechanism 2, which controls whether the suction or irrigation function is enabled in instrument 1.

FIG. 1 also shows two connection features 7 a and 7 b. In the depicted embodiment, connection feature 7 a is a flexible tube that couples a surgical irrigation fluid (liquid or gas) source (not shown) to instrument 1 so that irrigation fluid can be routed from a source through feature 7 a, proximal end mechanism 2, transport shaft 3, and wrist 4 to exit via end effector 5. Similarly, connection feature 7 b is a flexible tube that couples a surgical suction source (not shown) to instrument 1 so that matter from a surgical site can be drawn into end effector 5, and through wrist 4, transport shaft 3, proximal end mechanism 2, and connection feature 7 b, to the source. In the depicted embodiment, optional metal coils 8 are positioned around connection features 7 a,7 b near proximal end mechanism 2 so as to prevent features 7 a,7 b from kinking. Other known anti-kink technology may be used in other embodiments.

FIG. 2 is a plan view of proximal end mechanism 2, which shows the side 200, which mates with the robotic manipulator, according to some embodiments. In some embodiments, side 200 is coupled to a support platform for holding surgical instrument 1. Side 200 may be a supporting side of surgical instrument 1, according to embodiments disclosed herein. A supporting side of surgical instrument 1 is a side of the instrument that couples to a supporting arm in a robotic instrument or a holding platform for the instrument. In some embodiments, a supporting side of the instrument may be a side that rests directly on the hand of a user manually controlling the surgical instrument. As shown, four disks 9 a-9 d are mounted in proximal end mechanism 2, and each disk receives a unique input from an external servomotor. Consistent with some embodiments, disks 9 a-9 d may be associated with wrist control, suction control, irrigation control, and roll control. According to one embodiment, disks 9 a and 9 b are associated with wrist 4 control, disk 9 c is associated with control of the suction function, and disk 9 d is associated with the irrigation function. Also shown are the ends of engagement latches 10 a, and 10 b, which when latched release instrument 1 from its associated robotic manipulator sterile interface feature. Latches 10 a and 10 b ensure a simple disengagement between disks 9 a-9 d and their associated drivers.

Further according to some embodiments, a roll motion of transport shaft 3 may be executed using one of disks 9 a-9 d. In such embodiments, a single disk may be used to control irrigation and suction valves. For example, by rotating a disk counter-clockwise, a suction valve may be opened and an irrigation valve may be closed; and by rotating the disk in a clockwise rotation an irrigation valve may be opened and a suction valve may be closed. Further, a neutral position of the controller may leave both irrigation and suction valves closed.

FIG. 3 is a perspective view of proximal end mechanism 2 with its protective cover removed, showing certain internal components. FIG. 3 shows a chassis 11 (the reverse side of which is shown in FIG. 2) on which other mechanism 2 components are mounted. According to some embodiments, the reverse side of chassis 11 is coupled to a support platform for holding surgical instrument 1. Four control shafts 12 a-12 d extend through chassis 11. One end of each shaft 12 a,12 b is coupled to a unique associated disk 9 a,9 b and the other end of each shaft 12 a,12 b coupled to chassis 11. Similarly, one end of each shaft 12 c,12 d is coupled to a unique associated disk 9 c,9 d and the other end of each shaft 12 c,12 d is coupled to valve assembly 13, which in turn is mounted to chassis 11. Transport shaft 3 is also mounted to chassis 11. A small portion 14 a of the enclosed channel 14 is shown, which provides a passage for either irrigation or suction between end effector 5 and valve assembly 13. In the depicted embodiment, portion 14 a is made of rigid metal but could be other suitable material in other embodiments.

FIG. 4 is a perspective view of wrist orientation control features in proximal end mechanism 2. As shown in FIG. 4, two clamping pulleys 15 a 1, 15 a 2 are mounted on shaft 12 a. A 0.018-inch diameter tungsten cable (tendon) 16 a 1, 16 a 2 is wrapped around and secured to each associated unique clamping pulley 15 a 1,15 a 2, and the pulleys are secured to shaft 12 a so as to maintain tension in the cables. The cables 16 a 1,16 a 2 ride over stainless steel pin 17 a as they enter the interior of transport shaft 3. In a similar way, two clamping pulleys 15 b 1, 15 b 2 are mounted on shaft 12 b; cables 16 b 1, 16 b 2 are wrapped around and secured to pulleys 15 b 1, 15 b 2, and cables 16 b 1, 16 b 2 ride over stainless steel pin 17 b as they enter transport shaft 3. Pins 17 a, 17 b provide a sufficient bearing surface for the cables to keep friction concerns within limits for the designed-for life of the instrument, and in other embodiments a material other than stainless steel may be used. Likewise, tungsten provides sufficient strength, wear resistance, and resistance to stretching for the depicted embodiment, although in other embodiments other metal or polymer materials may be used, depending on design requirements.

The wrist control design illustrated in FIG. 4 contains a relatively low number of inexpensive parts, and so enables a relatively lower manufacturing cost in comparison to other designs. For example, U.S. Pat. No. 6,817,974 B2 discloses a gimbal mechanism to control the wrist cables. The embodiment depicted in FIG. 4 is a simple and relatively low cost design that enables the instrument to be disposed after use in a single surgical procedure.

FIG. 5 is a perspective view of the distal end of transport shaft 3, of wrist mechanism 4, and of end effector 5. As shown in FIG. 5, wrist mechanism 4 is a two-stage flexible “snake” design that includes a proximal link 18, a middle link 19, and a distal link 20. Link 18 is coupled to the distal end of transport shaft 3, and end effector 5 is coupled to link 20. The first stage between links 18 and 19 provides a degree of freedom in pitch, and the second stage between links 19 and 20 provides a degree of freedom in yaw (again, these are arbitrary terms). In the depicted embodiment, wrist mechanism 4 is capable of about a 45-degree orientation change in any direction. Three of the four wrist control cables (tendons) 16 a 1, 16 b 1, 16 a 2, 16 b 2 are visible, and each is routed through links 18 and 19 to be secured to link 20. Each of the tendons 16 may in some embodiments be a single cable, wire, or similar piece, and in other embodiments each of the tendons 16 may be a rigid hypotube (made of, for example, tungsten) to provide rigidity along its length, with cables crimped at the proximal and distal ends for coupling within the proximal end mechanism and the wrist mechanism.

Referring to FIG. 5A, an embodiment of the wrist control scheme is illustrated. The view is from the distal end looking towards the proximal end, with “pitch” being movement in the 6 to 12 o'clock directions about a “pitch” axis formed by the 3 to 9 o'clock directions. According to FIG. 5A, a “yaw” motion includes movement in the 3 to 9 o'clock directions about a “yaw” axis formed by the 6 to 12 o'clock directions. As shown in FIG. 5A, the cables are positioned symmetrically around the wrist perimeter: cable 16 b 1 is at about the 1:30 clock position, cable 16 a 2 is at about the 4:30 clock position, cable 16 b 2 is at about the 7:30 clock position, and cable 16 a 1 is at about the 10:30 clock position. Referring to FIG. 4 and its associated description, it can be seen that moving a single input disk 9 does not result in a “pure” pitch or yaw movement. Instead, to produce solely a pitch or yaw motion, both disks 9 a and 9 b are moved in coordination. Thus the two wrist control inputs are coordinated to provide a desired change in end effect or orientation. This coordinated control movement can be routinely done using known control system programming techniques.

For example, in some embodiments consistent with the present disclosure a pitch motion may be obtained by pulling/pushing cables 16 a 1 and 16 b 1 by the same amount. Even though cables 16 a 1 and 16 b 1 have been described above as “tendons,” it should be clear that the term is not limiting as to the use of cables or tendons 16 a 1 and 16 b 1 for either pushing, or pulling actions. Likewise, a pitch motion may be obtained by pulling/pushing cables 16 a 2 and 16 b 2 by the same amount. This configuration may correspond to disks 9 a and 9 b moving at the same speed, in the same direction. In some embodiments consistent with the present disclosure, a yaw motion may be obtained by pulling/pushing cables 16 a 1 and 16 b 2 by the same amount. Likewise, a yaw motion may be obtained by pulling/pushing cables 16 a 2 and 16 b 1 by the same amount. This configuration may correspond to disks 9 a and 9 b moving at the same speed, in opposite directions.

Referring once again to FIG. 5, end effector 5 includes a single center channel 21 and several end effector sidewall holes 22 through to the center channel 21. Center channel 21 is coupled to a coil-reinforced flexible tube 14 b (other tubes may be used; tube selection may depend on particular wrist mechanism designs) that is routed through the center of disks 18, 19, and 20 in wrist mechanism 4. Channel 21 is also coupled to another tube (not shown in FIG. 5; see e.g. a proximal end shown in FIG. 3), element 14 a at the proximal end of the instrument to provide the suction/irrigation channel 14 through instrument 1. Disks 18, 19, and 20 each have an inner opening (e.g., 0.165 inches) along axis 6, allowing a sufficiently large tube 14 b to be used to provide sufficient irrigation and suction for use at the surgical site. Sidewall holes 22 enhance the end effector's suction function.

FIG. 5B is another perspective view of the distal end of transport shaft 3, wrist mechanism 4, and end effector 5. FIG. 5B shows wrist 4 in a flexed position in both pitch and yaw. FIG. 5B also provides a perspective of tube 14 b.

FIG. 6 is a cross-sectional perspective view of proximal end mechanism 2 and a proximal portion of transport shaft 3, taken along longitudinal axis 6. FIG. 6 shows that irrigation feature channel 23 and suction feature channel 24 both join central channel 14 so that irrigation fluid (e.g., water) can be directed into central channel 14 via irrigation channel 23 and suction material (e.g., insufflation gas, smoke, blood, tissue residue, etc.) can be withdrawn from central channel 14 via suction channel 24. As shown, both feature channels 23, 24 join central channel 14 at about a 30-degree angle, which improves flow rates and reduces clots in the suction channel. In the depicted embodiment, irrigation channel 23 is positioned distal of suction channel 24. In other embodiments the relative positions may be reversed. In addition, in some embodiments either the suction or irrigation channel may be eliminated so that only one of the suction or irrigation functions is provided. FIG. 6 also shows an optional auxiliary channel 25 that joins central channel 14. In the depicted embodiment, auxiliary channel 25 is longitudinally aligned with central channel 14, and in other embodiments channel 25 may be angled with reference to channel 14.

According to embodiments disclosed herein, a plane including an irrigation channel and a suction channel may be perpendicular to a plane S including a side of a surgical instrument adapted to couple to a support platform. For example, the plane including channels 23 and 24 is perpendicular to chassis 11, which forms a side of instrument 1 coupled to provide support, according to some embodiments (see FIG. 6). Such configuration allows for a compact arrangement of a surgical instrument coupled to a robotic manipulator. For example, in surgical instrument 1 connection features 7 a and 7 b freely extend out when the instrument is placed in a robotic arm; avoiding interference with other parts and components in the robot (see FIG. 1).

Communication between irrigation feature channel 23 and central channel 14 is controlled by movable valve piston 26. Likewise, communication between suction feature channel 24 and central channel 14 is controlled by movable valve piston 27. Access to auxiliary channel 25 is via a removable screw cap 28 and insufflation seal 29. The straight alignment between channel 25 and channel 14 in the depicted embodiment allows a long, thin instrument (not shown) to be inserted into channel 14 for, e.g., cleaning or access to the surgical site through channel 21 in end effector 5. Seal 29 provides a seal around the inserted instrument's shaft. In some embodiments, additional fluid (gas, liquid) may be passed via channel 25 to channel 14 and thence to the surgical site.

FIGS. 7A, 7B, and 7C are cross-sectional perspective views that illustrate valve design and operation. The operation of the suction control valve is shown, and the irrigation control valve is similarly designed. As shown, the suction control valve includes a valve body 30, movable valve member 31, actuation piece 32, and robotic actuation piece 33. In some embodiments, robotic actuation piece 33 is a pinion gear. In the depicted embodiment, the suction control valve is a piston-type valve, although other simple valve designs (e.g., rotary valve with lever actuation) could be used. As depicted, valve body 30 is cylindrical (non-circular cross-sections may be used in other embodiments), and valve member 31 moves linearly inside valve body 30. Seals 34 provide a fluid-tight seal between valve body 30 and valve member 31 as it moves. A coil spring 35 positioned in valve body 30 pushes against valve member 31 to keep valve member 31 in a default closed position, although in alternate embodiments the design may be easily modified to keep the valve member in a default open position, or to eliminate the spring and require positive action (manual or robotic) to move the valve between closed, intermediate, and full open positions. A cross-ways channel 36 in valve member 31 provides an open passage between suction feature channel 24 and central channel 14 when the valve member is moved to an intermediate or full open position.

The movement of valve member 31 may be controlled by either manual or robotic actuation when instrument 1 is mounted on a robotic manipulator. Further, instrument 1 may be removed from the robotic manipulator and manually operated. Thus, instrument 1 is configured to function both as a robotic and a manual instrument, depending on the particular need during a surgical procedure. Actuation piece 32 includes a manual button 32 a and a rack gear 32 b. Actuation piece 32 is positioned to move valve member 31 inside valve body 30. By pressing on button 32 a in the direction of valve member movement, an operator directly moves the valve member. Likewise, motion of rack gear 32 b moves the valve member. Combining button 32 a and rack gear 32 b in a single actuation piece 32 (e.g., a single, unitary structure as shown, although the actuation piece may have several components in other designs) provides a simple way of allowing both manual and mechanical control of the valve member. Skilled artisans will appreciate that other mechanical configurations, such as the use of one or more sector gears, may be used to provide mechanical control in a manner similar to the use of a linear rack and pinion as shown. Nevertheless, the rack and pinion as shown is a space-efficient design that allows one, two, or more such valve actuation mechanisms to be placed in a small space. In addition, the placement of the one or more buttons 32 a around the instrument allows single-handed operation of the one or more associated valves, either when the instrument is mounted on the robot or is held in the hand. For example, when mounted on a robot manipulator, the thumb may be used to press on button 32 a of one valve with a pinching motion against supporting digits on the other side of the instrument. Similarly, another digit may be used to press on button 32 a of another valve with a pinching motion against a supporting thumb on the instrument. Likewise, if the instrument is held in the palm of the hand, the thumb may be used to press on one button 32 a and another digit may be used to press on another button 32 a.

FIG. 7B illustrates manual operation of surgical instrument 1. During manual actuation, an operator presses (depicted by the arrow P) button 32 a, which moves valve member 31 to position channel 36 in at least partial alignment with suction feature channel 24, as shown in FIG. 7B. When the operator releases pressure from button 32 a, spring 35 returns valve member 31 towards the closed position, either reducing or stopping the suction flow.

FIG. 7C shows the operation of surgical instrument 1 according to some embodiments consistent with the present disclosure. During robotic (telerobotic) actuation, a servomotor is activated to turn disk 9 c, which in turn rotates shaft 12 c (see FIGS. 2 and 3). Robotic actuation piece 33 is coupled to shaft 12 c, and so rotates with shaft 12 c. In the depicted embodiment, actuation piece 33 is a pinion gear that is meshed with rack gear 32 b, so that as disk 9 c turns, piece 33 exerts a force, (depicted by arrow F), on piece 32. Actuation piece 32 presses on valve member 31 to move it to an intermediate or full open position. The compression force of spring 35 is selected to accommodate the robotic actuation force. It can be seen that robotic actuation piece 33 can be rotated in an opposite direction to move, or to allow spring 35 to move in part or in full, valve member 31 towards a partially or fully closed position.

According to embodiments consistent with the present disclosure, a suction control valve and an irrigation control valve may be linearly actuated valves. Some embodiments may include either a suction control valve or an irrigation control valve, or both a suction control valve and an irrigation control valve being rotationally actuated valves. Furthermore, in some embodiments the actuation axis of an irrigation control valve and a suction control valve may be aligned in a plane parallel to the side S of a proximal end mechanism that mates with a robotic manipulator. This may be side 200 of chassis 11, according to some embodiments disclosed herein (see FIG. 2). This configuration allows for a compact form factor of a surgical instrument as in embodiments disclosed herein. A configuration having irrigation and suction control valves in a plane parallel to the side S may also provide mechanical stability to the surgical robotic manipulator arm assembly. Thus, a surgeon or other personnel may exert a limited amount of torque on the arm assembly while manually operating the suction control valve or the irrigation control valve in a surgical instrument consistent with embodiments disclosed herein. Further according to embodiments disclosed herein, a plane including the actuation axis of an irrigation control valve and a suction control valve may be perpendicular to a plane including an irrigation channel and a suction channel. For example, the plane including piston 26 in an irrigation control valve and piston 27 in a suction control valve is perpendicular to a plane including channels 23 and 24 (see FIG. 6).

Further according to embodiments disclosed herein operation of an irrigation control valve and a suction control valve may be performed independently, either manually, robotically, or by a combination of manual and robotic operation. Thus, in some embodiments turning an irrigation valve “on” may not turn a suction valve automatically “off.” Likewise, turning a suction valve “on” may not turn an irrigation valve automatically “off.” Furthermore, when an irrigation control valve is turned “off,” a suction control valve may remain in an “off” position for a selected amount of time, after which it may be turned “on.” The lag time during which an irrigation control valve is “off” and a suction control valve is “off” may be arbitrarily selected by a controller or surgeon, depending on the surgical conditions. Likewise, when a suction valve is turned “off,” an irrigation valve may remain in the “off” position for a selected amount of time, chosen by a controller or a surgeon depending on the surgical conditions.

FIG. 8 shows a flowchart of a method 800 to use a surgical instrument according to embodiments disclosed herein. Method 800 may be performed manually by personnel in a surgical room, according to embodiments consistent with the present disclosure. In some embodiments, method 800 may be performed by an automated machine being controlled by a surgeon or other personnel. In some embodiments, some steps in method 800 may be performed manually and some steps in method 800 may be performed by an automated machine controlled by a surgeon. For the purpose of illustration, the method shown in FIG. 8 will be discussed in conjunction with FIG. 1. First, a distal end of instrument 1 is inserted inside a body wall of a patient (810). End effector 5 may then be moved in the distal end near a body area under surgery (820) and provide material exchange between outside of the body wall and the area under surgery (830).

According to embodiments consistent with the present disclosure, the surgical instrument used in method 800 may include an end effector at the distal end and an actuator mechanism at the proximal end. The actuator mechanism includes a movable shaft coupled to a tendon and another movable shaft mechanically coupled to a valve. The surgical instrument may further include a transport shaft coupling the actuator mechanism to the end effector. The transport shaft may have a lumen through which a plurality of tendons is coupled between the actuator mechanism and a flexible wrist, allowing control of a pitch and a yaw movement of the end effector. The surgical instrument may further include a channel enclosed in the lumen, the channel providing a cavity coupling the proximal end to the distal end, the cavity having a first aperture coupled to the first valve. Further embodiments of method 800 may include a surgical instrument consistent with surgical instrument 1, described in detail in the present disclosure.

According to embodiments of method 800 consistent with the present disclosure, moving the end effector in the distal end in step 820 may include a motion in a pitch degree of freedom and a motion in a yaw degree of freedom, as well as translating the entire distal end of the instrument along the pitch and yaw planes. In some embodiments of method 800 consistent with the present disclosure, the motion in a pitch degree of freedom includes moving a first movable shaft and a second movable shaft in the actuator mechanism in the same direction, at the same speed; and the motion in a yaw degree of freedom comprises moving the first movable shaft and the second movable shaft in the actuator mechanism in opposite directions, at the same speed.

In embodiments of method 800 consistent with the present disclosure, providing material exchange between outside of the body wall and the area under surgery in step 830 may include actuating the first valve in the actuator mechanism to provide passage of material from outside of the body wall to the area under surgery. Further, in some embodiments step 830 may include actuating a second valve in the actuator mechanism to provide passage of material from the area under surgery to outside of the body wall. According to some embodiments, step 830 may be performed using a manual force or a robotic force. The manual force may be provided by direct contact of a user hand with a proximal end of the instrument.

According to some embodiments, step 830 may include actuating a first valve in a proximal end of the surgical instrument to access a cavity included in a transport shaft of the instrument; wherein actuating the first valve includes actuating an actuator mechanism that includes a robotic control coupled to the first valve and a manual control coupled to the first valve in response to activation of the robotic control or the manual control in a direction perpendicular to a rotational axis of the robotic control.

Further according to some embodiments, step 830 may include coupling a material source to a cavity in the surgical instrument; coupling a suction source to the cavity in the instrument, and actuating a first valve coupled to the cavity to access the material source using an actuator mechanism including a robotic control coupled to the first valve and a manual control coupled to the first valve. Also, step 830 may include actuating a second valve coupled to the cavity to access the suction source using an actuator mechanism including a robotic control coupled to the second valve, and a manual control coupled to the second valve.

FIG. 9 shows a flowchart of a method 900 to use a surgical instrument according to some embodiments. Several operating variations are therefore achieved, as illustrated in FIG. 9. First, in accordance with aspects of the method, a distal end of the instrument may be inserted into a patient, and a proximal end of the instrument mounted to a surgical robotic system manipulator (910). A surgeon may telerobotically operate the instrument and its features. For example, the surgeon may telerobotically position and orient the instrument's end effector, as in step 920 a. Furthermore, the surgeon may telerobotically control the suction and irrigation functions to provide material exchange, as in step 930 a. Alternatively, while the instrument is mounted to the manipulator, the surgeon may position and orient the instrument's end effector manually, as in step 920 b. In some embodiments, the surgeon and a patient side assistant may coordinate operation of the suction and irrigation functions to manually provide material exchange, as in step 930 b. Step 930 b may be performed by direct contact of a user's hand with the proximal end of the instrument.

For example, while telerobotically operating other surgical instruments at the surgical site, the surgeon may verbally request more or less suction or irrigation, and the patient side assistant may comply by performing step 930 b. As another example, the surgeon may telerobotically operate either one of the suction or irrigation features as in 930 a, and the patient side assistant may manually operate the other one of the suction or irrigation features as in 930 b. The assistant's manual operation overrides the manipulator's commanded valve position, and the valve returns to its commanded position when the assistant releases the valve.

According to some embodiments consistent with the present disclosure, simultaneous suction and irrigation are possible. In such embodiments, teleoperation of a suction control valve and an irrigation control valve may be performed simultaneously. Likewise, manual operation of a suction control valve and an irrigation control valve may be performed simultaneously. Moreover, simultaneous operation of a suction control valve and an irrigation control valve may be performed by a combination of teleoperation of one of the valves and manual operation of the other valve. In some embodiments, the instrument may be removed from the robotic manipulator and the patient side assistant may manually operate the suction and irrigation functions as in 930 b.

It is understood that the sequence of steps in FIG. 9 is illustrative only, and different steps may be operated simultaneously or in combination with one another. For example, while a patient side assistant may perform 920 b to position the end effector of the instrument, the surgeon may perform 930 a for telerobotically irrigate an organ or a tissue with saline solution. Other combinations of steps and procedures consistent with FIG. 9 may be performed according to the present disclosure.

Embodiments disclosed herein are illustrative only and not limiting. One of regular skill in the art may realize that further embodiments consistent with the present disclosure may be provided. The present disclosure is more clearly defined in light of the following claims. 

1-20. (canceled)
 21. A surgical instrument comprising: a chassis configured to be removably coupled with a surgical robotic manipulator; an elongate flexible shaft coupled to the chassis; a robotic actuation piece coupled to and rotatable relative to the chassis; a manual actuator coupled to and translatable relative to the chassis; and a rack gear engaged with the manual actuator and with the robotic actuation piece, wherein the rack gear is movable by the robotic actuation piece and by the manual actuator to control an operation of the elongate flexible shaft.
 22. The surgical instrument of claim 21 further comprising: a rotatable input member coupled to the robotic actuation piece and configured to engage the surgical robotic manipulator.
 23. The surgical instrument of claim 22 wherein the rotatable input member is coupled to the robotic actuation piece by a rotatable shaft.
 24. The surgical instrument of claim 21 wherein the robotic actuation piece includes a pinion gear engaged with the rack gear.
 25. The surgical instrument of claim 21 wherein the manual actuator includes a button.
 26. The surgical instrument of claim 21 further comprising: a tendon extending through the elongate flexible shaft between the chassis and a distal portion of the elongate flexible shaft, the tendon actuatable to change an orientation of the distal portion of the elongate flexible shaft.
 27. The surgical instrument of claim 21 wherein the elongate flexible shaft includes a cavity extending therethrough.
 28. The surgical instrument of claim 27, wherein cavity is configured to provide passage for an irrigation fluid.
 29. The surgical instrument of claim 21 wherein an end effector is coupled to a distal end of the elongate flexible shaft.
 30. The surgical instrument of claim 21 wherein an axis of rotation of the robotic actuation piece is perpendicular to an axis of translation of the manual actuator. 